PRIORITY AREA 2:

COMMUNICABLE/INFECTIOUS

DISEASES

Topics

Bhutanese Refugees: A Threat to Nepalese regarding HBV Infection..............4

Prevalence of Nosocomial Infection in TUTH...................................................5

The Impact of Psoriasis in the Psychosocial Well Being of Chronic Psoriatic

Patients and their Family Members: A Community Based Study.....................6

Rapid Non-Invasive Diagnosis of Kala-azar......................................................7

A Report Surveillance of Multiple Drug Resistant (MDR) Bacterial Infections

among the Patients Attending to Different Out-patient Department (OPD) and

Hospitalized Patients in TU Teaching Hospital.................................................8

A Study on Correlation between Hepatitis B Surface Antigen and Liver

Function Test and the Possible Factors Responsible for Hepatitis B among the

Patients Attending Tribhuvan University Teaching Hospital.............................9

A Study on the Awareness Regarding Pulmonary Tuberculosis Among Carpet

Workers of Productive Age Group (15-49 years) in Lalitpur district...............10

Awareness of Hepatitis B among Government High School Students of

Dharan Before and After Educational Intervention........................................11

Epidemiological Study of Microfilariasis in Three Different Geographical

Regions of Nepal............................................................................................12

Prevalence of Hepatitis B e Antigen Positive Cases among Hepatitis B Virus

Infected Patients............................................................................................13

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A Study on Socio-economic Determinants and Economic Burden of Japanese

Encephalitis in Kailali district of Nepal...........................................................14

Study on Practices/Knowledge and Recepies of Traditional Healers for

Treatment of Jaundice in Kathmandu Valley..................................................16

Socio-Economic Impact of DOTS Strategy on Tuberculosis Control (A Case

Study of Bhaktapur District...........................................................................17

Prevalence of Hepatitis-B among Clinically Suspected Patients Visiting

Ayurveda Hospital, Nardevi...........................................................................18

Socio-Behavioral Epidemiology and Ecological Determinants of Malaria

Outbreak in Kanchanpur District...................................................................19

Molecular Epidemiology of Malaria in Nepal..................................................20

Study on Association of Helicobactor Pylori Infectious with Acid Peptic

Disease (APD) among Nepalese....................................................................21

Research Report on Use of Polymerase Chain Reaction (PCR) for the

diagnosis of malaria in Nepal........................................................................22

Compliance of Tuberculosis Patients with Treatment Banke, Bardiya &

Surkhet Districts............................................................................................24

Immunohistochemical Study of Tuberculous Lymphadenitis.........................26

Post Operative Wound Infection....................................................................28

Prevalence of Lymphatic Filariasis in Districts of Eastern Nepal: A Population

Based Cross-Sectional Household Survey.....................................................29

Comparative Study of Awareness regarding HIV/AIDS among Transportation

Workers and Female Sex Workers of Sunsari and Morang Districts...............30

Serological-Epidemiological and Molecular Study of Dengue Viruses in Nepal

......................................................................................................................31

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Gender Differences Delays in Initiating Tuberculosis Treatment among

Tuberculosis Patients, Far Western Development Region, Nepal...................33

Prevalence of Pulmonary Tuberculosis among HIV Infected Persons in

Pokhara, Kaski, Nepal....................................................................................35

Loop Mediated Isothermal Amplification for the Direct Detection of Human

Pulmonary Infection with Mycobacterium Tuberculosis, Mycobacterium Avium

Complex and Mycobacterium Kansasii from Sputum....................................37

Skin Diseases: Prevalence and Impact in the Quality of Life of the Community

Members in a Rural VDC................................................................................39

A study on Risky Behavior on Kala-azar Outbreak among Socio-Economically

Poor and Marginalized Communities of Jhapa district, Nepal........................40

Role of Serology, Neuroimaging and Stool Examination in Diagnosis of

Neurocysticercosis.........................................................................................41

Risk Assessment on STIs and HIV Transmission among Migrant Labours in

Rukum District...............................................................................................42

Jajarkot Diarrhoea Outbreak, 2009................................................................43

Outbreak Investigation Report of Influenza like Illness (ILI) in Jajarkot District

in 2015..........................................................................................................45

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Bhutanese Refugees: A Threat to Nepalese regarding HBV Infection(1998)

Shah BK1, Bhattacharya SL1

1B.P.Koirala Institute of Health Sciences, Dharan, Nepal.

Background

The carrier rate of Hepatitis B surface antigen is 6% in Bhutan and 1% in

Nepal as per World Health Organization 1997 report. Since outbreaks of viral

hepatitis are also known, its high prevalence in a migrated community if any

may be a potential threat to the rest of the local people. So this study was

carried out on Bhutanese refugees living in refugee camps located in Eastern

region of Nepal to find out the prevalence of Hepatitis B surface antigen

carrier rate among them.

Methods

This prospective sero-epidemiological study was carried out in Beldangl II

camp. With the help of semi-structured questionnaire, 500 volunteers

enrolled, were interviewed for the risk factors for Hepatitis B virus

transmission. Blood samples of 467 samples were tested for Hepatitis B

surface antigen by immunoassay based on immunochromatographic

sandwich principle.

Results

Out of 467 samples, 4 were positive for Hepatitis B surface antigen, an

incidence of 0.85%.

Conclusions

Hepatitis B surface antigen carrier rate was found to be low in Bhutanese

refugees. It was also found that they were not engaged in any practice that

could increase the chances of Hepatitis B virus transmission. Thus, this study

shows that, the refugees are not a threat to the local people as far as

Hepatitis B virus transmission is concerned.

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Keywords: Bhutanese refugees; carrier rate; hepatitis B surface antigen

(HBsAg); hepatitis B virus (HBV).

Prevalence of Nosocomial Infection in TUTH (2000)

Lamichanne DR, Shrestha P

Background

Nosocomial infection is the infection acquired by patient, patient party or

hospital staff from hospital. Generally infection occurring after 48 hours of

hospital stay is said to be hospital acquired.

Methods

A cross-section observational study was done. In this study, ten different

wards of Tribhuwan University Teaching Hospital were observed. Total of 171

patients were observed.

Results

Out of 171 patients, 4 were found to have Nosocomial infection. The point

prevalence of such infections in the hospital was calculated to be 2.35%.

Conclusions

The commonest form of Nosocomial infection was infection of surgical

wound.

Keywords: Nosocomial infection; point prevalence; prevalence; surgical

wound.

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The Impact of Psoriasis in the Psychosocial Well Being of ChronicPsoriatic Patients and their Family Members: A Community Based

Study (2001)

Shrestha DP1, Gyawali K1

1Institute of Medicine, Kathmandu, Nepal.

Background

Psoriasis is a common and chronic dermopathy with significant impact in the

physical activities and the psychosocial well being of the patients.

Methods

The patients for the interview were selected from psoriatic patients with

severe disease of at least 5 years duration, from those attending the

Tribhuwan University Teaching Hospital and B & B Hospital and those

diagnosed of having psoriasis in the community interactive programme

conducted during the study. Along with the patients some family members

were also identified. Altogether 21 patients and 9 family members were

interviewed.

Results

Most patients and family members are convinced that it is not a contagious

disease. Community members had mistaken it for leprosy and think that it is

contagious. Patients tend to hide the disease and they worry that it will come

in visible places and other members of community will see it. Spouse, family

members and friends are in general supportive. Community members

discriminate against the patients which is the main reason of fear and

sadness in patients. Itching and scaling give problem to some extent. The

patients were very sad and worried because the disease doesn't get cured, it

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may be related to some other serious disease and it may be transmitted to

children.

Conclusions

Social stigmatization is the main problem due to psoriasis and this in turn is

responsible for sadness, fear and worry in the patient's life.

Keywords: discrimination; impact; psoriasis; psychosocial well being.

Rapid Non-Invasive Diagnosis of Kala-azar (2001)

Gyawali K, Thapa S, Devkota B, Yadav CS

Background

Kala-azar is endemic throughout central and eastern terai region of Nepal

bordering the Indian state of Bihar. Lack of knowledge, unavailable simple

and reliable diagnostic test and poverty-all contribute to late diagnosis and

institution of an effective chemotherapy; thereby maintaining the potential

human reservoir at high level in the community. Since invasive diagnostic

method is an unacceptable test of choice in the endemic region, an

alternative technique is a dire necessity. The present study evaluated

recombinant K-39 Leishmania test with splenic aspirate in hospitalized Kala-

azar patients.

Methods

This was a retrospective review of hospital case record of Kala-azar patients

admitted during the months of Poush- Chaitra 2057. All hospital case notes

of the 4 months with the diagnosis of Kala-azar were screened. Shukraraj

Tropical and Infectious Disease Hospital, Teku was taken as the study area.

Results

The rK-39 Leishmania dipstick achieved a high sensitivity (96%) and high

positive value (95%). The dipstick is a simple, reliable and a robust

technique.

Conclusions7

The rK-39 Leishmania dipstick is an acceptable test of choice in the diagnosis

of Kala-azar and may be of great utility especially in the endemic districts

where invasive methods are neither applicable nor appropriate.

Keywords: endemic; Kala-azar; positive predictive value; rK-39 Leishmania

dipstick; sensitivity.

A Report Surveillance of Multiple Drug Resistant (MDR) BacterialInfections among the Patients Attending to Different Out-patient

Department (OPD) and Hospitalized Patients in TU TeachingHospital (2001)

Tuladhar NR1

1Department of Clinical Microbiology, Institute of Medicine, Maharajgunj

Campus and Tribhuwan University Teaching Hospital.

Background

Multi Drug Resistant bacterial isolates have been frequently reported from

different parts of the world as an emergence of treatment problem. Such

Multi Drug Resistant bacterial strains have also been increasingly isolated

from the clinical specimens of the hospitalized patients as well as the

patients attending to out-patient services of TU Teaching Hospital. To know

the exact situation of different types of Multi Drug Resistant strains, this

surveillance study was carried out.

Methods

A total of 6955 clinical specimens during six months period beginning from

July 12, 2000 to January 12, 2001 were investigated in Tribhuwan University

Teaching Hospital. The antimicrobial drug resistance testing of the isolates to

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the various antibiotic disks was carried out according to standardized disk

diffusion method recommended by NCCLS.

Results

Of the total isolates 634 during six months period from clinical specimens

2505 of the hospitalized patients, 271 Multi Drug Resistant strains (42.74%)

were found; the most predominant were Esch.coli 88, Pseudomonas

aeruginosa 62, Klebseilla sp. 58 and Staph. aureus 30. Among the patients

attending to out-patient department services, 254 Multi Drug Resistant

strains (17.82%) were found from 1425 isolates of the total specimens 4450

in the study period; the most predominant were Esh.coli 99 followed by

Klebseilla sp. 50, Staphylococci aureus 44 and Pseudomonas aeruginosa 38.

Conclusions

Understanding the genetics of resistance, the practitioners and other

categories of health provider need to understand the dosage and timing in

the treatment of particular infections. Before use of antibiotics one should

know which is specified for a particular bacterial infection.

Keywords: antibiotic; bacteria; infection; misuse; multi drug resistant;

overuse; resistant.

A Study on Correlation between Hepatitis B Surface Antigen andLiver Function Test and the Possible Factors Responsible for

Hepatitis B among the Patients Attending Tribhuvan UniversityTeaching Hospital (2001)

Gyawali K1, B.C.RK1, Devkota B1, Acharya B1

1Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal.

Background

Hepatitis B is one of the major diseases of human and is a serious global

public health problem. Although Nepal is low endemic for Hepatitis B it is

responsible for significant cause of morbidity and mortality.

Methods

The study was conducted among the patients attending Tribhuwan University

Teaching Hospital. Total 78 Hepatitis B surface antigen reactive sera and

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patients along with 54 liver function elevated (both icteric and non icteric)

were studied to explore the facts.

Results

It was found that 20% of Hepatitis B surface antigen reactive cases

correlated with the liver function test indicating Hepatitis B virus a major

threat of jaundice in or part. Amazingly of the total reactive case 14 % were

found to have decreased albumin concentration a state of clinical

emergency. Tracing the possible source of infection heterosexual activity was

found most common (23%) but shockingly 6.4% of the patients were

suspected to be transmitted from unhygienic surgical procedure during

vasectomy and only few (8%) were found to have knowledge regarding

Hepatitis B virus transmission and vaccination.

Conclusions

Sterilization at any level of surgical practice and educational program is

recommended to eventually stop the virus from transmission.

Keywords: Hepatitis B virus; Hepatitis B surface antigen; infection;

knowledge; liver function test; transmission.

A Study on the Awareness Regarding Pulmonary TuberculosisAmong Carpet Workers of Productive Age Group (15-49 years) in

Lalitpur district (2001)

Rajbhandari N1

1Tribhuwan University Institute of Medicine, Nursing Campus, Maharajgunj,

Kathmandu, Nepal.

Background

The carpet industry is the highest industrial employment generator in Nepal

and has become particularly beneficial to the mass work force that is

illiterate or hardly had any education background. The risk of Tuberculosis

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infection is more in carpet factories because of overcrowding, poor

environment, lack of working space, ignorance of health care.

Methods

A descriptive study was conducted from 2nd Baisakh to 4th Jestha 2058. Data

was collected from 100 respondents in 8 different carpet factories using

simple random sampling procedure. Questionnaire was used to collect

information from the respondents.

Results

More than half of the respondents (60%) had high level of awareness.

75.35% respondents had knowledge about transmission, only 13.40% had

knowledge about cause, more than 60% had knowledge about signs and

symptoms and 40.21% had knowledge about vaccination against pulmonary

tuberculosis. 72.16% respondent knew about the treatment but only 45.71%

had knowledge about correct duration of medicine. 85.57% respondents

knew the treatment available place. Only 28.57% respondents had no

knowledge about preventive measures of pulmonary tuberculosis. 82.47%

respondents showed good attitude towards the patients of pulmonary

tuberculosis.

Conclusions

Only a small number of respondents had high level of awareness and access

to wide range of different sources of information that helps to obtain

knowledge on pulmonary tuberculosis.

Keywords: attitude; awareness; carpet factory; knowledge; pulmonary

tuberculosis.

Awareness of Hepatitis B among Government High School Studentsof Dharan Before and After Educational Intervention (2001)

Gurung K1, Gautam K1

1B.P.Koirala Institute of Health Sciences, Dharan, Nepal.

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Background

Hepatitis B virus, a silent killer is the major cause of morbidity and mortality.

Children are 230 times more likely to develop these. Awareness on

transmission of Hepatitis B virus is needed to protect our future generations

from this infection.

Methods

A quasi-experimental study design was conducted among government high

school students of Dharan. Three government schools were selected using

lottery method. Equal number of students (45) from each class was selected

by simple random sampling technique and interviewed by using semi-

structured questionnaire. Data were analyzed in frequency and percentage

by using Two Population Proportion Test.

Results

There was significant increase (p<0.005) in the level of awareness of

students in Post interventional test. A significant number of students 71.1%

(p<0.005) came to know about all types of Hepatitis virus after the

intervention.

Conclusions

There was significant increase in the level of awareness of Hepatitis B among

government high school students of Dharan after the educational

intervention. Educational intervention was found to be effective.

Keywords: awareness; educational intervention; government school;

hepatitis B; post test; pre-test.

Epidemiological Study of Microfilariasis in Three DifferentGeographical Regions of Nepal (2001)

Manandhar R

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Background

Bancroftian filariasis is spreading as an endemic in many parts of Nepal and

is a major public health problem. This paper deals with the prevalence of

micrifilaraemia and filarial disease studying their association with individual

characteristics and variables related to exposure to the vectors.

Methods

The survey was conducted in Bhaktapur, Palpa and Bhairahawa covering

three different geographical regions between January 2001-November 2001.

Microfilaria was examined by multiple diagnostic techniques using blood

collected between 20.00-01.00 as well as ICT card method. The male/female

aged between 20 and 65 years were interviewed with questionnaire.

Results

The risk of being microfilaria was greater among those who had lived in the

study area for more than 15 years. The disease prevalence was 0.31%. The

chronic clinical manifestation was found in both male and female and was

increased with age. The cases of hydrocele in male were noticed more in

terai and inner terai but microfilaraemic cases detected in hill. The survey

showed that smear from buffy coat of night blood was the best to find

microfilaria. ICT card method was found very satisfactory for diagnosis of

antigenemia in Wuchereria bancrofti infection.

Conclusions

Detection of parasite from microfilaraemia cases was found low compared

with the laboratory diagnosis of antigenemia in Wuchereria bancrofti

infection. In Bhaktapur district many cases of leg encephalitis were observed.

Hydrocele cases were found more in terai and inner terai area but

microfilaria was not detected from the urine specimens.

Keywords: filariasis; hydrocele; microfilaraemia; prevalence.

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Prevalence of Hepatitis B e Antigen Positive Cases among Hepatitis

B Virus Infected Patients (2002)

Mishra AK

Background

Hepatitis B is one of the most common viral infections affecting mankind. It

is a major public health problem occurring endemically in all parts of the

world. Nepal is a country with mixed prevalence of Hepatitis B virus infection.

Prevalence of Hepatitis B in general population is low (Hepatitis B Surface

Antigen 1% anti Hepatitis B Surface Antigen 8%) but moderate to high

incidence of infection is observed in certain ethnic groups.

Methods

A cross-sectional prospective study was carried out among 100 consecutive

patients in the Liver unit at Bir Hospital from 1st Baisakh 2059 to 31st Jestha

2059. The presence of Hepatitis B e Antigen was done by Enzyme Linked

Immunoabsorbant Assay (ELISA) method.

Results

Among 97 patients, 19 patients were found to be positive for Hepatitis B e

Antigen indicating the percentage of positivity to be 19.6%. The Hepatitis B

Surface Antigen and Hepatitis B e Antigen were both found to be most

prevalent in the age group of 20-29.

Conclusions

The Hepatitis B Surface Antigen and Hepatitis B e Antigen were both found to

be prevalent in the most productive age group. So if they become carrier

there is high chance that they would transmit the disease to their respective

wives and hence to the newborn babies.

Keywords: Hepatitis B; Hepatitis B e antigen; Hepatitis B surface antigen;

incidence; infection; prevalence.

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A Study on Socio-economic Determinants and Economic Burden ofJapanese Encephalitis in Kailali district of Nepal (2002)

Adhikari SR, Sharma BP

Background

Japanese encephalitis is emerging as a serious public health problem in

Nepal. The diagnosis and treatment of the JE patient has financial

consequences to the society.

Methods

The study was based on primary as well as secondary sources. However, the

study relied mainly on primary data. For primary data, 60 households with

Japanese encephalitis patients, 30 male and 30 female, were randomly

selected from the list of Japanese encephalitis patients from the hospital

records. Pre-designed, pre-tested questionnaires were administered, to

collect quantitative information from the sampled household. Focus group

discussion with health personnel, Japanese encephalitis patients, caretakers

and key informants were also conducted to obtain in-depth information.

Simple statistical tools such as averages, standard deviations, correlations

between variables to explain the nature of relationship and test of

significance have been used. Disability Adjusted Life Years calculation has

been made using the formula outlined by Murray.

Results

The direct cost which was the out of pocket cost of Japanese encephalitis

treatment involved medical cost, transportation cost, and food expenses. The

average total direct cost was Rs. 5281 per patient. A positive relationship (r

=» 0.24) between food expenses and per capita income was observed. The

average total time loss of the household (both patients and caretakers) was

90 person days. The average total resource cost was Rs. 10613 which was

almost 15 percent of the average annual income. Of the total Japanese

encephalitis household, 88 percent had borrowed loans for Japanese

encephalitis treatment and the maximum amount borrowed was Rs. 9000.

The total Disability Adjusted Life Years lost was 493.92. The study estimated

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a Disability Adjusted Life Years of 365.70 reduced as a result of treatment

provided by local health system. The study while analyzing the determinants

of Japanese encephalitis identified several risk factors as environmental

factors, occupational factors, level of income (poverty) factors, knowledge

and behavioral factors and cultural factors.

Conclusions

Japanese encephalitis is a rural based disease and a disease of the poor. It

imposes multidimensional impact such as economic burden on the

household, burden on the local health system, burden on society and

increase in the marginal poor. Japanese encephalitis had an impact not only

on the income but on the sources of income as well which effected their

future income flow and prospects of a better future.

Keywords: determinants; disability adjusted life years; economic burden;

Japanese encephalitis; risk factors.

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Study on Practices/Knowledge and Recepies of Traditional Healersfor Treatment of Jaundice in Kathmandu Valley (2003)

Koirala RR1, Khaniya BN1Nardevi Ayurveda Chikitsalaya Vikas Samiti, Hospital Complex, Nardevi,

Kathmandu, Nepal.

Background

Traditional healers in Kathmandu Valley treat a wide variety of conditions.

They are especially renowned for their ability to cure jaundice and other

common ailments. Most resident of Kathmandu, even those who do not

usually seek Ayurvedic treatment, will consult a traditional healers when,

during the course an illness, they or family members become jaundiced.

Approximately one third of the visits to the traditional healers in the city are

for jaundice. This research was designed to find the applicable and

practically successful knowledge of local healers for treatment of particular

disease- jaundice.

Methods

Twenty traditional healers renowned in Kathmandu, Lalitpur and Bhaktapur

districts were selected. Questionnaires and interview were used as data

collection tools.

Results

Majority of traditional healers hesitate to talk over the knowledge of healing

with other people and never transfer their knowledge to other except within

their own family member. The research found four different methods

(process means the mechanism how the used herbs work to cure jaundice

used by the traditional healers) of treatment of jaundice by the healers. They

were a) Oral application of drugs- results vomiting b)Oral application of

17

drugs- results diarrhea c)Using drugs (in the form of paste) at naval

periphery d)Using through the nasal passage (drug in liquid state)- results

nasal discharge e)Sweating f) Stimulate and liver.

Conclusions

There is an urgent need to document the knowledge and forward scientific

intervention for further research.

Keywords: jaundice; knowledge; methods; traditional healer; traditional

knowledge; treatment.

Socio-Economic Impact of DOTS Strategy on Tuberculosis Control (ACase Study of Bhaktapur District) 2003

Subedi LP, Khanal A, Sharma B, Subedi IP, Rana P, Raut RK

Background

The Directly Observed Treatment Short Course (DOTS) has considerable

impacts on patients of tuberculosis in terms of knowledge, attitude and

socio-economic condition. The study aimed to know the socio-economic

impact of DOTS on tuberculosis patients.

Methods

The study was conducted from September 2002-March 2003 at Bhaktapur

district. In the study, 305 registered in 19 DOTS centers and sub-centers of

Bhaktapur district from July 2002-February 2003 was set as universe. Among

these 120 patients from nine different DOTS centers and sub-centers were

considered for the study. A purposive sampling method was employed for the

selection of respondents. Semi-structured interview, group discussion and

key informant interview were performed to collect the primary information.

Results

The most economically active (15-59 years) adults are under the high risk of

tuberculosis. Expenditure for investigation, travel and nutritious diet was

higher among the patients. The illness increased the expenditure (for18

medical treatment, transport and food) and loss of productivity which

reduced the income. Loss of workdays was highest among the wage labours.

The cost incurred seeking diagnosis in private hospitals is higher than that in

government hospitals. However, DOTS decreased the period of work loss due

to its strong follow up and regular drug consumption provision which

ultimately helped the patients to recover their income.

Conclusions

DOTS is available and accessible to all level of people and plays a significant

role in reducing social stigma attached to the disease by caring the patient

through regular supervision and observation.

Keywords: directly observed treatment short course; impact; provision;

socio-economic; strategy; tuberculosis.

Prevalence of Hepatitis-B among Clinically Suspected PatientsVisiting Ayurveda Hospital, Nardevi (2003)

Gyawali P1

1Tribhuwan University, Institute of Medicine, Ayurveda College, Kirtipur,

Kathmandu, Nepal.

Background

Hepatitis B is a major public health problem in Nepal. Though a fatal disease

having more hazardous result and consequences has been ignored and

neglected compared to other diseases due to improper awareness policies

and most important of all being inadequate research techniques and

expensive equipments.

Methods

This was cross-sectional study carried out in Kaya Chikitsa (General

Medicine) Out-patient department of Ayurveda hospital, Nardevi from 1st July

to 15th December 2003. 200 patients suffering from jaundice were selected

using simple random sampling technique. Questionnaire was used to collect

information from the respondents.

Results

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Among 200 patients, 8% were found positive for Hepatitis B. The result

showed that 6.5% male and 1.5% female were positive for Hepatitis B. The

age group 20-30 years is mostly found to be infected with Hepatitis B.

Conclusions

Children are relatively safe if their parents were not infected with Hepatitis B.

Various percent prevalence of the infection was encountered from 20 to 30

years of age which is the most productive age group.

Keywords: clinically suspected patients; Hepatitis B; infection; prevalence.

Socio-Behavioral Epidemiology and Ecological Determinants ofMalaria Outbreak in Kanchanpur District (2003)

Chand KB, Mahat BB, Joshi YP, Joshi HR

Background

Malaria is a disease which has direct impact on productivity of people due to

work loss, reducing work capacity and increasing work burden. In such

condition, in developing countries there appears a vicious cycle of poverty.

This study aims to find out the socio-behavioral epidemiology and ecological

determinants of malaria outbreak in Kanchanpur district.

Methods

The study was conducted in malaria outbreak wards of Jhalari and Krishnapur

VDC of the study area during April 2003 to November 2003. Out of 2150

households of the study area, 215 households were selected using

constructed random numbers. Information was collected through structured

questionnaire. The blood samples were collected from the symptomatic

suspects of malaria and examined. A total of four focused group discussions

were conducted in each respective ward in order to get the deeper

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understanding on the subject of the study. The search and review of the slide

positive malaria cases were done from the record of Epidemiology and

Disease Control Division, District Public Health Office, Vector Borne Disease

Research and Training Center, health posts, sub-health posts and hospital to

establish prevalence of malaria in selected wards.

Results

The prevalence of slide positive malaria was found to be 26.09%. The

reported prevalence was 26.09% and 20.37% among male and females

respectively. The study also revealed that out of 215 respondents, 92.25%

were engaged in agriculture. Regarding the treatment pattern of malaria,

81.94% were found to be treating at government health institutions.

Households with bed net were 91.5%. Out of 207 animals shed, 53.14% were

built at less than the distance of 20 feet. Out of 215 respondents in average,

60.92 had unsatisfactory peri-domiciliary environment.

Conclusions

There is not any clear factor which caused malaria outbreak in the

communities which means there are multiple factors responsible in the

occurrence of malaria.

Keywords: determinants; epidemiology; malaria; outbreak; prevalence;

socio-behavioral.

Molecular Epidemiology of Malaria in Nepal (2003)

Parajuli K1, Khatri Y1

1Central Department of Microbiology, University Campus, Tribhuwan

University, Kirtipur, Kathmandu, Nepal.

Background

The distribution and the molecular finger print of the existing strain of the

malaria and the indigenous inherent species was not yet disclosed. In this

regard, molecular epidemiology of malaria in the context of Nepal is an

essential area to be studied.

Methods

The study was carried out in Kanchanpur district from July 2003 to December

2003. A total of 676 blood samples were collected from individual malaria

21

suspected patients attending malaria clinic, District Public Health Office and

different sets of camps. Giemsa stained thin and thick blood smears were

examined microscopically and compared with the Rapid Diagnostic Test

which was finally followed by Polymerase Chain Reaction. The observations

thus obtained were documented/analyzed and comparative study was

performed.

Results

Among the total, 374 patients attended in malaria clinic the positive cases

for malaria were 80 in which 10 cases were of Plasmodium falcifarum and 70

cases were of Plasmodium vivax. The total of 302 patients attended in the

camp where the positive cases for malaria were 68 in which 27 cases were of

Plasmodium falcifarum and 41 cases were of Plasmodium vivax. The

sensitivity, specificity, positive predictive value and negative predictive value

of the optiMAL test for diagnosis of P. vivax was found to be 84.61%, 100%,

100% and 77.78% respectively. Similarly, the sensitivity, specificity, positive

predictive value and negative predictive value of the optiMAL test for

diagnosis of P. falcifarum was found to be 85.71%, 100%, 100% and 92.85%

respectively.

Conclusions

Extensive study of malaria as molecular epidemiology should be conducted

for the determination of low parasitaemia and multiple infections.

Keywords: epidemiology; malaria; negative predictive value; optimal test;

positive predictive value; rapid diagnostic test; sensitivity; specificity.

Study on Association of Helicobactor Pylori Infectious with AcidPeptic Disease (APD) among Nepalese (2003)

Rai SK1

1Department of Microbiology, Nepal Medical College, Attarkhel, Jorpati,

Kathmandu, Nepal.

Background

Infection with H.Pylori is widespread. In developing countries, 8 in 10 children

by the age of 5 years and more than 90.0% of adults are infected. In Nepal,

prevalence of H.Pylori in various gastro duodenal diseases has been reported22

to be ranged from 39.0% to 86.6%. Present study was carried out to

investigate the prevalence of H.Pylori associated Acid Peptic Disease in

patients of different sex, age and ethnic.

Methods

This study was carried out in Kathmandu valley but with inclusion of all

patients with complain of Acid peptic disease both from inside and outside

valley and undergoing endoscopic examination. A total of 203 subjects were

included.

Results

One fifth of total patients included had severe stage of Acid peptic disease.

The Helico urease test positive rate increased significantly with the increase

of severity of Acid peptic disease. Present findings indicated that H.Pylori is

associated with over 75.0% of severe cases of Acid peptic disease.

Conclusions

One third of patients with Acid peptic disease problems are infected with

H.Pylori and needs specific treatment for the same. Public health education,

early detection of cases and specific treatment should be encouraged.

Keywords: acid peptic disease; helicobacter pylori; helico urease test

positive rate; incidence; infection.

Research Report on Use of Polymerase Chain Reaction (PCR) for thediagnosis of Malaria in Nepal (2003)

Ghimire P1

1Central Department of Microbiology, Tribhuwan University, Kathmandu,

Nepal.

Background

Polymerase chain reaction method has been found to be more sensitive for

Plamodium vivax (91%) and Plasmodium falcifarum (89%). Level of parasite

detection has been reported to be as low as 1 to 10 parasites per micro litre

23

of blood in patient sample. Diagnosis by polymerase chain reaction has also

been reported to be species specific for all four species of human

Plasmodium. Hence there is a need to evaluate a non-microscopic diagnostic

technique which should be sensitive, specific and may be available in central

facilities of the country for evaluation of drug efficacy, drug resistance to

study genetic diversity of parasite found in Nepal.

Methods

During the study period (January-September 2003) blood samples from 283

suspected malaria patients from Dhanusha and Kanchanpur districts located

in central and far western Nepal were collected and further analyzed utilizing

conventional Giemsa stained malaria microscopy and Polymerase Chain

Reaction based on 18sssr DNA gene.

Results

Out of total 283 samples only 66 (23.32%) samples were positive for malarial

parasite (Plasmodium falcifarum-26, Plasmodium vivax-40). The prevalence

of malaria in Kanchanpur district during the outbreak season 2003 was

23.32%. Plasmodium falcifarum malaria cases were 9.18% and Plasmodium

vivax malaria cases were 14.13% of the total collected cases whereas

39.39% and 60.60% of the total positive cases respectively. This rate of

prevalence is much higher than the expected national prevalence rate.

Comparative evaluation of polymerase chain reaction and Giemsa stained

blood smear microscopy method showed that polymerase chain reaction is

almost as sensitive as microscopy. Polymerase chain reaction could detect 2

cases of falcifarum malaria which could not be detected by microscopy.

Conclusions

Polymerase chain reaction is a useful diagnostic technique for malaria

diagnostic research especially in drug resistant and low parasitaemic cases.

Keywords: malaria; microscopy; plasmodium falcifarum; plasmodium vivax;

polymerase chain reaction.

24

Compliance of Tuberculosis Patients with Treatment Banke, Bardiya& Surkhet Districts (2004)

Pokhrel GS, Kandel SL

Background

Patient non compliance with treatment is the main problem in TB control

programme. DOTS strategy to treat TB patients has focused on non

compliance problem but need to do study on it to solve the existing problem.

25

The objective of this study is to determine the compliance of tuberculosis

patients with treatment and identify main factors affecting compliance of

tuberculosis patients with treatment.

Methods

In this cross-sectional study, districts were selected purposively and DOTS

treatment centers were randomly selected in Banke, Bardiya and Surkhet

districts. All patients who completed one month or more treatment and came

to helath facility for drug (n=380) were interviewed using a structured and

semi-structured questionnaire. Collected data were processed and analyzed

on computer.

Results

Out of total respondents, 63.3% were economically productive with male and

female ratio of 2:1. About 69% of the respondents were farmer. In

employment status, labour group had statistically significant lower

compliance (p value=0.004). Similarly low income status group and terai

ethnic group had also lower compliance with p value=0.035 and 0.00073

respectively. Patient non compliance was higher in large family and

statistically significant (p value<0.05). Among the 380 respondents, 94%

were new TB patients and 46% were sputum positive. Based on respondents

perception, 45% respondents were given information regarding taking

regular medicine, 29% self protection, about disease 24%, 20% proper

sputum disposal. Most of the non compliance group were not given

information about disease and treatment had lower compliance with

statistically significant association (p value<0.05). About 64% respondents

collected drug once a week, 29% daily and rest of the others on a monthly

basis. Those who collected drugs in short interval had higher compliance (p

value=0.006).

Conclusions

The compliance of TB patients is found to be quite high in the study area.

Poverty, large family size, low education status, inadequate awareness about

disease and treatment arisen by health worker and no proper advice given

by the private practitioners were causes of non compliance. In order to

26

reduce the number of non compliance, it is suggested to improve

information, education and communication prior to TB treatment and follow

up.

Keywords: compliance; control; DOTS; non compliance; patients; services;

tuberculosis.

27

Immunohistochemical Study of Tuberculous Lymphadenitis (2004)

Pokharel S1

1Central Department of Microbiology, Trubhuwan University, Kirtipur,

Kathmandu, Nepal.

Background

Diagnosis of tuberculous lymphadenitis on the basis of clinical finding in

combination with Fine

Needle Aspiration Cytology (FNAC) of the lymph node aspirate or

hematoxylin-eosine staining of the lymph node biopsy is common in practice.

Additional staining of the specimen by Ziehl- Neelson (Z-N) stain may provide

a step toward better diagnosis of the cases. Use of alternate method for the

diagnosis of tuberculous lymphadenitis may be essential, thus

immunohistochemical staining of the lymph node biopsies in combination

with Z-N stain may yield a better diagnosis specially in case of lymph node

tuberculosis. Study of the immunological changes like effect on T cells/ B

cells/ on the lymph nodes during the infection period could be useful in early

diagnosis of tuberculous lymphadenitis. Keeping all these factors in mind,

this work has been planned to evaluate the efficiency of

immunohistochemical staining in the diagnosis of tuberculous lymphadenitis.

Methods

This study was conducted at Patan hospital, during September 2002 to March

2003. Altogether, 40 biopsies collected at Department of Pathology, Patan

Hospital were further analyzed. 40 biopsy specimen were stained with

Haematoxylin - Eosin stain and Acid fast stain where as 20 biopsies were

stained with CD3/ CD20/ S-100 stains respectively and the biopsy cell/tissue

features were analyzed.

Results

Among 40 cases of suspected tuberculous lymphadenitis cases, 100% cases

showed tuberculosis positive in Haematoxylin-Eosin stain. Whereas Acid Fast

Bacilli could be detected in only 10% of the cases. Greater prevalence of

tuberculous lymphadenitis was observed between 20-30 years of age with

higher percentage of female’s involvement. Frequency of Cervical and

28

axillary nodes involvement were higher than other. In 57.5% of cases, right

cervical nodes and in 20% of the cases, axillary nodes were found involved.

Multiple nodes involvement was observed in 80% of the cases and bilateral

nodes in only 20% of the cases. CD3 cells were present in higher numbers

than CD20 cells. CD3 cells were confined to paracortical areas where as

higher CD 20 cells were found in follicular area. But due to migratory nature

of CD20 cells, they were also found in other parts of lymph nodes.

Conclusions

Immunohistochemical staining techniques, though specific, H-E staining and

AFB staining in combination still remains a method of choice for the

diagnosis of tuberculous lymphadenitis, in developing country like Nepal,

because of cost benefit and availability of immunohistochemical staining

reagents.

Keywords: biopsies; immunohistochemical; lymphadenitis; nodes; staining;

tuberculosis.

29

Post Operative Wound Infection (2004)

Shrestha ML1, Khadka N1

1Bir Hospital, Kathmandu, Nepal.

Background

Post Operative Wound Infection remains significant causes of post operative

morbidity. This prospective study was undertaken to establish whether the

endogenous organisms lodged in tissue are the cause of post operative

wound infection.

Methods

Patients undergoing surgery in General Surgery Unit II, Bir Hospital were

studied for a period of 12 months and they were prospectively followed up till

the stitches were removed for the development of wound infection.

Results

A total of 227 of 325 were followed up till the removal of the stitches. The

overall incidence of wound infection was 7.92%. Factor that was found to be

significantly associated with post operative wound infection was the

endogenous organisms lodged in the tissue during the surgical procedure.

Use of povidon iodine has reduced the bacterial positivity in the skin and

subcutaneous tissue significantly.

Conclusions

Endogenous organisms lodged in the body tissue has significant role in

incidence of post operative wound infection. Bacterial positivity can be

reduced by the use of povidon iodine and this in turn reduces the post

operative wound infection caused by endogenous organisms.

Keywords: bacterial positivity; endogenous organisms; post operative

wound infection.

30

Prevalence of Lymphatic Filariasis in Districts of Eastern Nepal: APopulation Based Cross-Sectional Household Survey (2005)

Agrawal CS1, Jha N1, Khanal B1, Agrawal S1

1B.P.Koirala institute of Health Sciences, Dharan, Nepal.

Background

Lymphatic Filariasis is a major public health problem in various parts of the

world. It causes permanent and progressive physical disability. Some 120

million people are infected worldwide and the disease is endemic in more

than 80 countries and territories. The present study was undertaken to

assess the knowledge of study population about lymphatic filariasis and to

estimate the prevalence of the disease in Morang, Sunsari and Saptari

districts of Eastern Nepal.

Methods

This study was carried out in three districts (Morang, Sunsari and Saptari) of

eastern Nepal over a period of three months. Approximately 100 households

(400 individuals) were selected by systematic random sampling technique.

The filarial survey was comprised of the survey proforma and night blood

collections by the laboratory technician. All information was put in the pre

coded format. The analysis was done using Statistical Package for Social

Sciences (SPSS) 10.0.

Results

The overall prevalence of lymphatic filariasis from a 10000-studied

population from three districts of eastern Nepal was 0.1%. District wise

31

prevalence of lymphatic filariasis was 0.07% and 0.2% in Morang and Saptari

respectively.

Conclusions

A health education program can be developed based on the data from the

present study.

Keywords: eastern Nepal; knowledge; lymphatic filariasis; prevalence.

Comparative Study of Awareness regarding HIV/AIDS amongTransportation Workers and Female Sex Workers of Sunsari and

Morang Districts (2007)

Sharma D, Regmi R, Pandit A, Rana R, Nepal B

Background

Nepal's vulnerability to HIV/AIDS is fueled by poverty, gender inequalities,

low levels of education and literacy, denial, stigma, and discrimination.

Though the absolute number of HIV/AIDS cases is still low, there are already

"concentrated" epidemics within certain high-risk behaviour groups in Nepal.

The main purpose of the study was to compare level of awareness on

HIV/AIDS among transportation workers and female sex workers of Sunsari

and Morang districts of Nepal.

Methods

It was a descriptive cross-sectional study. Morang district was selected

purposively as study area. Altogether 256 transportation workers were

selected using simple random sampling technique. Similarly 256 female sex

workers were identified from different cities of Morang and Sunsari districts

using snowball sampling technique. Data was edited, coded, recoded and

tabulated. Data analysis was done with descriptive method with the use of

cross table and statistical tools in Statistical Package for Social Sciences

software win 12 version.

Results

32

Comparing the awareness of female sex workers (48%) and transportation

workers (52.3%), transportation workers are found a bit more aware then the

female sex workers.

Conclusions

The female sex workers are more risky groups than transportation workers to

acquire HIV/AIDS

Keywords: female sex workers; HIV/AIDS; level of awareness; transportation

workers.

Serological-Epidemiological and Molecular Study of Dengue Virusesin Nepal (2008)

Pandey BD

Background

Dengue fever (DF) and more severe forms namely dengue hemorrhagic fever

(DHF) and dengue shock syndrome (DSS) are caused by dengue virus,

transmitted by Aedes mosquito. DF/DHF is primarily a disease in tropical and

sub tropical areas of the world. Dengue virus infection occurs in more than

100 countries and over 2.5 billion people live in the areas with a risk of

infection. Up to 100 million cases of DF and 500,000 cases of DHF and

several thousand deaths are estimated to occur annually worldwide. During

the past decades, dengue virus emerged in South Asia and DF/DHF

epidemics occurred in Bhutan, India, Maldives, Bangladesh and Pakistan. In

Nepal, the first case of dengue was reported on 2004 from Chitwan district.

The recent outbreak of 2006 was observed in nine districts of Terai including

Banke, Dang and Parsa, poses a serious threat of future epidemic of dengue

in Nepal.

33

Methods

A total of 422 serum samples were collected during viremic period from the

patients suspected DF, JE and other viral illness from August to November

2007 in nine districts of Terai region of Nepal and 127 samples were also

collected from asymptomatic individuals. IgM ELISA, IgG-ELISA was

performed using particle agglutination assay (PA) and IgM ELISA kit on serum

samples for both dengue and JE. RNA extraction was performed using

QIAGEN RNA EXTRACTION kit from the serum samples collected during

viremic phase followed by RT-PCR.

Results

The result showed that 28 % of the cases were positive for dengue-IgM out of

422 collected serum samples. There was no haemorrhagic manifestation

observed among the patients. Bardiya districts showed highest percentage of

positive dengue antibodies (64%). Stegomyia indices seasonal changes

related to rain were identified in all the major cities affected during the 2006

DF/DHF outbreak. To know the possible time of interdiction of dengue in

Nepal, IgG ELISA was performed and gave only one positive case out of 127

asymptomatic individuals. Among analysed IgM antibody positive cases,

69.06% were male and 30.88% were female and the highest numbers of

positive cases were found in an age group 21-30 (29 %). There was no

significant difference was observed in relation to age, sex and occupations of

the patient and dengue infection. Two serological methods, PA and ELISA

were used to compare their sensitivity and specificity for the detection of IgM

antibody of dengue and the result showed that PA assay has sensitivity of 98

% and specificity of 96 %, a positive predicts value of 0.90 and negative

predict value of 0.99 in comparison with IgM-capture ELISA. Since PA assay

does not required sophisticated instruments and specialized manpower it

could be useful and reliable diagnostic test to support clinical diagnosis in

district hospitals of Nepal. Molecular diagnosis based on RT-PCR was also

performed in an optimize condition for rapid and confirmatory diagnosis and

to know the dengue serotype prevalent in Nepal. However, RT-PCR failed to

show positive for dengue indicating inappropriate time for collection or

34

transportation. Virus isolation is undergoing with the collaboration of

international collaborator.

Conclusions

The sero-epidemiological study on dengue viruses was conducted in Terai

region of Nepal from August to December 2007 shows that 28 % of the

febrile patients were positive for dengue infection. In view of the report of

outbreak in 2006 it indicates that dengue is firmly established in Terai region

of Nepal. It is expected that more extensive outbreak can occur in the

coming year with the start of rainy season.

Keywords: dengue viruses; outbreak; sensitivity; specificity; sero-

epidemiological; terai region.

Gender Differences Delays in Initiating Tuberculosis Treatmentamong Tuberculosis Patients, Far Western Development Region,

Nepal (2008)

Bam TS

Background

In Nepal, at least twice as many men as women are registered for TB

treatment. Long diagnostic delay among women has even more adverse

effects, as the health and welfare of children and other family members are35

closely linked to that of the mothers. Therefore, reducing delays in TB health

seeking and diagnosis is especially important among women. This study

aims to investigate the gender differences for delay in initiating directly

observed treatment short-course (DOTS), among new pulmonary

tuberculosis patients.

Methods

This cross-sectional study was carried out in Kailali and Kanchanpur districts

of Far Western Development Region between Mansir 2063 and Chaitra 2063.

Both quantitative and qualitative methodologies were applied. All the

registered new smear positive pulmonary tuberculosis patients under 4

randomly selected DOTS centres of the Kailali and Kanchanpur districts

between Mansir 2063 to Chaitra 2063 were the sample population. Four

focus group discussions were carried out among the different communities. A

standard structured questionnaire was prepared in English and then it was

translated by professional translators into Nepali. Modified grounded theory

and cut and paste techniques were used for qualitative data analysis. All

analyses were conducted using the SPSS statistical package, version 13 for

quantitative data.

Results

The mean patient delay was 2.71 months in females and 2.64 months in

males. This difference was not statistically significant (p>0.05). The mean

patient delay in all patients was 2.67 months. The mean provider delay was

found longer in both males (2.86 months) and females (7.58 months).

Moreover, it was significantly longer among females than males (p <0.05).

The mean total delay was 5.51 months in males and 10.21 months in

females. This difference was highly significant (p<0.001).

Conclusions

It was observed that provider delay was significantly longer in female than

male patients. The risk factors for patient delay and provider delay identified

in this study should be the area under discussion of future interventions in

order to reduce delay in delivery of DOTS treatment to tuberculosis patients

36

in general and female TB patients in particular, and hence transmission of

the disease in the community.

Keywords: delays; far-western region; gender differences; patients;

treatment; tuberculosis.

Prevalence of Pulmonary Tuberculosis among HIV Infected Personsin Pokhara, Kaski, Nepal (2008)

Verma SC1, Dhungana GP2, Joshi HS1, Kunwar HB3

37

1Department of Community Medicine, Manipal College of Medical Sciences,

Pokhara, Nepal, 2Department of Microbiology, Siddhanath Science Campus,

Mahendranagar, Nepal, 3National TB Control Programme, Nepal.

Background

Tuberculosis kills more people than any other single infectious diseases. The

disease is more prevalent in crowded, low income groups, alcoholics,

smokers, close-contacts of known tuberculosis cases and surprisingly high in

immuno-compromised persons, particularly in HIV infected persons, both in

persons with prior tuberculosis infection who are newly infected with HIV and

in persons with prior HIV infection who are newly infected with tuberculosis.

This study aims to explore HIV/TB co-infection pattern in HIV infected

persons of Pokhara, Kaski, Nepal

Methods

This work was carried out at the Regionl TB centre (RTC), Pokhara during

December 2006 to December 2007. Altogether 184 HIV positive persons

were included in the study. HIV positive persons were selected from Friends

of Hope (FOH), Ranipauwa, Community Support Group (CSG), Damside,

Nauloghumti (New Road) and Paluwa (Srijana Chowk). HIV positive person’s

selection was done by random sampling method using the lists available in

the respective sites. 50% of 368 HIV positive persons registered over one

year in the above organizations working for HIV/AIDS were randomly selected

to get a sample size of 184. After taking informed consent, they were

interviewed to fill up the pre-structured questionnaire. Then, specimens were

collected for investigation of TB. The sputum specimen was collected for 3

times (The first Spot specimen, early morning specimen, and second spot

specimen). All the specimens were transported to the Mycobacteriology

Research Laboratory, RTC and specimen processing was done as per

standard Microbiological operating procedure. Data processing and analysis

was done by using SPSS 11.5 (Statistical Package for Social Science version

11.5)

Results

38

Overall prevalence of TB was found to be 6%. Prevalence of tuberculosis is

higher in males (8.2%) in comparison to females (2.7%). All the TB/HIV co-

infected patients were in the productive age group i.e., 21-40 years.

Conclusions

HIV positive persons showing sign and symptoms of TB should immediately

be subjected to the diagnosis of TB and vice versa. Specific guidelines

regarding their investigation and treatment should be formulated and put

into effort as a part of HIV care and support service.

Keywords: co-infection; HIV; prevalence; TB/HIV; tuberculosis.

39

Loop Mediated Isothermal Amplification for the Direct Detection ofHuman Pulmonary Infection with Mycobacterium Tuberculosis,Mycobacterium Avium Complex and Mycobacterium Kansasii

from Sputum (2009)

Pandey BD

Background

Rapid species identification and proper use of drugs are key requirements for

the effective treatment and case management of tuberculosis. The

development and evaluation of new diagnostic technique, which can

diagnose causative agent in simple and rapid way, is the necessity of this

century. Loop-Mediated Isothermal Amplification (LAMP) provides new

possibilities of above requirements for direct detection of M. tuberculosis, M.

avium complex and M. kansasii in sputum samples.

Methods

This study was carried out 130 sputum samples from suspected pulmonary

tuberculosis patients were included in this study. All these samples were

processed for flurochrome staining and were subjected to culture and LAMP.

Thus sputum specimens were included in this study to compare them with

microscopy, culture and LAMP.

Results

Among them 50(38.46%) were found to be positive by flurochrome staining,

culture and LAMP. Similarly 48(36.92%) samples were negative by all

diagnostic methods. 1(0.77%) microscopy and culture positive sample was

negative by LAMP. Similarly 3(2.31%) microscopy and LAMP positive cases

were negative by culture. 3(2.31%) culture positive cases were negative by

both microscopy and LAMP. Eight (6.16%) culture negative cases were

positive by LAMP where as 17(13.07%) microscopy negative samples were

positive by culture and LAMP. Out of 78(100%) total LAMP positive cases,

76(97.44%) were positive for M. tuberculosis and remaining 2 (2.56%) were

positive for M. intracellular. While comparing LAMP results with gold standard

culture, the sensitivity, specificity, predictive value of positive test, predictive

40

value of negative test, percentage of false negative and percentage of false

positive of LAMP were found to be 94.36%, 81.36%, 85.90%, 92.31%, 5.63%

and 18.64% respectively. Similarly, LAMP had sensitivity 98.14% and

specificity 67.11% while compare with microscopy.

Conclusions

LAMP is highly sensitive and specific molecular technique, which can be used

effectively for the diagnosis of clinically, microscopically, and culturally

confusing cases thus facilitating the effective treatment and case

management of tuberculosis and other atypical mycobacterial infection. Due

to its easy operation and rapid amplification efficiency, it can be used in well-

equipped laboratories for clinical use if sample preparation, nucleic acid

extraction and cross-contamination controls are addressed.

Keywords: loop mediated isothermal amplification; M. avium complex, M.

kansasii, M. tuberculosis.

41

Skin Diseases: Prevalence and Impact in the Quality of Life of theCommunity Members in a Rural VDC (2009)

Shrestha DP1

1Department of Dermatology, Maharajgunj Campus, Institute of Medicine,

Kathmandu, Nepal.

Background

Skin diseases are the most common health problems, for which community

members seek health care in Nepal. Skin diseases are responsible for severe

disabilities and are among the major cause of social stigmatization. There is

significant impact of skin diseases in the quality of life of the community

members. Most skin diseases are preventable and treatable.

Methods

This is a community based cross sectional descriptive study. First a baseline

household survey was done in Talku dudhechaur VDC. Then 4 health camps

were conducted in the same VDC, during which skin diseases were

diagnosed. The patients diagnosed with chronic and/or severe skin diseases

were interviewed with Dermatology Life Quality Index questionnaire with

additional questions.

Results

The overall prevalence was 20.1%, with a slightly higher prevalence in

females (22.5%) than males (18%). The prevalence of skin diseases in

children was 28.1%. The Dermatology Life Quality Index score ranged from 7

to 19 with a mean score of 10.7±3.2. Among all skin diseases, five groups of

disorders – eczemas, pigmentary disorders, acne, urticaria & pruritus – were

the skin problems with highest prevalence and highest impact on the quality

of life of the community members. The 10 most common skin diseases seen

were eczemas, pigmentary disorders, p.alba, acne, urticaria, moles & lumps,

pruritus, viral infections, pyodermas & fungal infections.

42

Conclusions

Common skin problems are easily preventable and treatable at the

community and primary health care level. A coordinated and timely

intervention towards prevention and management of skin diseases is

essential for overall health development of the Nepalese population.

Keywords: impact; management; prevalence; prevention; skin diseases;

skin problems; quality of life.

A study on Risky Behavior on Kala-azar Outbreak among Socio-Economically Poor and Marginalized Communities of Jhapa

district, Nepal (2009)

Samudaik Swastha Paryawaran Sundhar Kendra, Damak, Jhapa, Nepal.

Background

Kala-azar is a re-emerging serious public health problem in the terai region of

Nepal and one of the major threats to public health. This research aims to

study the risk behavior for Kala-azar outbreak among socio-economically

poor and marginalized communities.

Methods

A descriptive study was carried out in two VDCs of Western Jhapa for a period

of three months. The main target population was the marginalized

communities having at least 2 cases of Kala-azar detected among the

selected VDCs. Data was collected using structured questionnaire and

analyzed using Statistical Package for Social Sciences.

Results

It was found that more than half of the respondents (55%) were aware

regarding danger of Kala-azar. Only 48% of the respondents had good

knowledge and among them only 39% had good practice. Respondents

knowledge was found to be significantly associated with their practices

(p<0.001). Similarly, respondents attitude also associated significantly with

their practices (p<0.001). Knowledge, attitude and practices of the

respondents were found to be significantly associated with their preventive

awareness (p<0.001).

Conclusions

43

The awareness regarding Kala-azar and sand fly control measures was found

to be satisfactory. More emphasis should be laid on putting this knowledge

into practice which can be achieved by more aggressive health education

campaigns in the community through the health workers and involving

schools in the community.

Keywords: attitude; awareness; kala-azar; knowledge; marginalized;

outbreak; poor; practice.

Role of Serology, Neuroimaging and Stool Examination in Diagnosisof Neurocysticercosis (2010)

Sapkota K, Sapkota K, Dumre SP, Karmacharya K, Thapalia A, Singh S

Background

Neurocysticercosis (NCC) is the infection of Central nervous system by the

larval stage of Taenia solium (pork tapeworm). This tapeworm is a public

health problem in most developing countries where pigs are raised and pork

is consumed and where poverty, illiteracy and deficient sanitary

infrastructure are common. The main objective of this study is to find out the

diagnostic significance of Serology and Neuroimaging and to detect intestinal

carriers of the tapeworm.

Methods

The design of the research is exploratory and descriptive and also analytical.

It is based on qualitative questions, the laboratory data and imaging studies.

The study site is Manipal Teaching Hospital (MTH), Pokhara. The patients of

pediatric age group (age 1 to 15 years) who visit to the pediatric department

either as an out-patient or in-patient are included in the study. During the

study period from January 2008 to January 2010, a total of 200 samples of

44

serum for serology and Stool for microscopy was collected and

microbiologically processed.

Results

Out of 200 samples of serum, 100 were from the cases with diagnosis of

Neurocysticercosis. Pig rearing was seen in 26% of the cases. And 30% (8) of

pig rearing children had harbor taenia species in intestine. The most

commonly affected age group was 8-14 years. ELISA sensitivity, specificity,

positive predictive value and negative predictive value were 87%, 84%,

84.7% and 86.6% respectively.

Conclusions

Neurocysticercosis should be suspected in any cases with neurological

symptoms (especially partial seizure) in Taenia endemic regions.

Neuroimaging should be done in cases with clinically and epidemiologically

suspected Neurocysticercosis to identify the type, location, nature/stages

and number of intracranial lesions.

Keywords: cases; diagnosis; Neurocysticercosis; Neuroimaging; serology.

Risk Assessment on STIs and HIV Transmission among MigrantLabours in Rukum District (2003)

Budathoki HB, Devkota GP

Background

Studies carried out in Nepal have shown a higher than average prevalence of

STIs and HIV/AIDS among female sex workers, common intravenous drug

users, transport workers, migrant labours compared with rest of the people.

There is a scarcity of fact data about the number of migrant labours in Nepal.

It is projected about 80 percent of total male independent population and 5

percent of total independent female population are being emigrated from

Rukum to India either due to poor economic condition or Maoist insurgency.

This study therefore focuses on assessing the risk of STIs and HIV/AIDS

transmission among migrant labours in Rukum district.

Methods

45

The study depends mainly on primary data derived from a descriptive design

with clinical examination, serological testing and survey questionnaire. A

total of 180 migrant labours including 172 males and 8 females were

selected from different 10 VDCs of Rukum district. Data entry, processing

and analysis were done in Epi-info statistical software.

Results

About 15.57% of blood sampled migrant labours got affected with Syphilis.

Likewise 7.78% and 1.16% of blood sample had fallen under Gonorrhoea and

Trichomonas Vaginalis respectively. Most of them were infected with multiple

infections like Syphilis and Gonorrhoea. Among the blood sampled populace,

one was found to be infected with HIV/AIDS. Risk factors associated with

transmission of STIs and HIV/AIDS were less use of condom, poverty, Maoist

insurgency, isolation from their life partners, high intension of sexual arousal

keeping secret of STIs and HIV/AIDS problems, lack of knowledge about the

modes of transmission and preventive measures, not following medical

treatment, lack of personal hygiene and sanitation etc.

Conclusions

Syphilis, Gonorrhoea and Trichomonas are still common than HIV infections

and there is low prevalence of HIV infection in population of Rukum. However

non-recognition of condom use as proper way to protect onself against

HIV/AIDS put the population at risk of greater epidemic.

Keywords: gonorrhea; HIV/AIDS; migrant labours; prevalence; risk; syphilis;

trichomonas vaginalis.

Jajarkot Diarrhoea Outbreak, 2009

Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal.

Background

The information on outbreak was first noticed when the public media

highlighted about a death and large number of diarrhea cases in Rokaya

village development committee (VDC) of Jajarkot district on 20th Baisakh

2066. The Rapid Response Team was mobilized on 21 Baisakh 2066 in the

same VDC and treated 224 patients. The mortality reduced to zero by the

46

end of Jestha 2066. According to the District Public Health Office Jajarkot and

the public media, the morbidity and mortality due to diarrhea started

increasing from the third week of Ashad.

Methods

The Nepal Health Research Council (NHRC) called a meeting and felt the

need to specify the agents responsible for outbreak by conducting an

outbreak investigation from research perspective. The Executive Chairman

chaired the meeting and formed a member team for outbreak investigation.

This team was responsible to collect epidemiological data and stool

specimens to know the epidemiological pattern of disease as well as

confirmation of diagnosis. A laboratory technician joined the team in Jajarkot

with required transport media to collect stool specimen. Epidemiological data

were analyzed by the team of Nepal Health Research Council and the

laboratory samples were diagnosed by National Public Health Laboratory.

Results

There was one district hospital and primary health care center in the Jajarkot

district. Similarly, there were maximum of 25 sub health posts; one in each

VDC. Out of the total morbidity 425 as registered in DHO hospital Khalanga,

58% were male and 42% were female. 15-44 age-group which was the

productive age group, was extremely affected by the diarrhoea.

Disadvantaged Janajatis were in the range of highly affected caste group.

There has been maximum number of morbidity (97) in the fourth week of

Ashad. From the fourth week of Jesth the number of mortality increased

gradually and reached at peak (38) in the fourth week of Ashad. However

this trend decreased in the first week of Shrawan. Out of the total 13 lab

tests, 5 were diagnosed Vibrio cholera, Salmonella and no microorganism

were detected from the test. On average the Attack Rate was 8.2% and CFR

was 1% with number of cases and deaths of 12,500 and 128 respectively.

Around 10 deaths out of 128 were in the health institutions, which showed

that those patients who had access to public health institutions had less

number of mortality.

Conclusions

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Productive age group and disadvantaged group are highly affected. The

trend of morbidity was steady and no mortality was observed till the end of

Jesth. There was a sudden increase in morbidity and mortality from the

month of Ashad. Morbidity trend is still increasing till the first week of Ashad,

whereas mortality trend is decreasing. Causative agents responsible for

outbreak might be V. cholera.

Keywords: attack rate; case fatality rate; health institutions; morbidity;

mortality; outbreak.

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Outbreak Investigation Report of Influenza like Illness (ILI) inJajarkot District in 2015 (2015)

Background

The World Health Organization defines influenza like illness (ILI) as an acute

respiratory infection with measure fever of ≥38 C◦, cough and with onset

within the last 10 days. This year onset of ILI outbreak in Jajarkot district was

reported on 1 April (18 Chaitra) 2015 when it came in media that 20 students

of Archane VDC were ill and some deaths in next day. By the third week of

April, diseases had already noted in Paink, Sakla, Nayabada, Telegaun, Rami

Danda, Rokayagaun, Laha, Kortang and Majkot and could spread to all 30

VDCs of the district and surrounding districts like Kalikot, Rukum, Salyan,

Dolpa, Jumla, Surkhet and Dailekh in the absence of strong public health

response and early treatment indicating the rapid spread of disease.

Methods

We carried out planning meeting at central and district level for collecting

data for the study. Record of death cases were collected from District Public

Health Office and outpatient visit line list was obtained from health facilities

and camps of three VDCs: Talegaun, Archane and Pajaru. The death cases

reported from these three VDCs was verified by our team using verbal

autopsy questionnaire. The probable cause of reported death was confirmed

by an independent team of expert. In-depth interviews were conducted with

health professionals and patients. Records of laboratory confirmed influenza

A or swine flu cases was obtained from National Public Health Laboratory and

were followed up via home visit and telephone conversation to assess

current situation after treatment. Exit client interviews were also conducted

in three VDCs.

Results

During the outbreak March-April 2015, more than 10,000 people received

treatment and 35 deaths from various diseases were reported. Among the

death cases, only 6 deaths (17%) were chronic obstructive pulmonary

disease (COPD) with ILI symptoms, 10 (29%) cases were COPD with

complications (without symptoms 0f ILI), 1 death was suspected ILI, causes

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of 7 deaths could not be identified bases on reported signs and symptoms

and rest cases were of rabies, neonatal infection, neonatal sepsis,

tuberculosis, drowning, severe malnutrition, breast cancer, Gullain Barre

Syndrome (GBS) illness etc. A total of 16 cases were found confirmed cases

of swine flu or H1N1 out of total 49 samples tested. Out of 3001 patients

visited for treatment in health camp and health institutions of Talegaun,

Pajaru and Archane, only 233 (7.8%) were suspected cases of ILI including

common cold. The probable major factors behind frequent outbreak of

communicable diseases in Jajarkot district were influx of migrating workers

from India, poor hygiene and environmental sanitation, low nutrition status of

people, low educational level as well as economic status, low awareness for

prevention and control of different health problems and diseases,

unavailability of health professionals at peripheral level health facilities, lack

of medicine compliance as well as high level of antibiotics supply from

pharmaceutical shop resulting drug resistance and high prevalence of

smoking and alcoholism.

Conclusions

Majority of cases visited for treatment were chronic patients of respiratory

illness, gastrointestinal problems as well as minor illness such as fever and

headache (>58%) and only few were ILI (8%). Most of the problems are

related to poor economic status of people, poor nutrition status, poor

practice of hygiene and sanitation, alcoholism and smoking.

Keywords: influenza like illness; investigation; outbreak; respiratory illness.

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